Surgical localization and control of gastro-intestinal bleeding

ABSTRACT

An instrument for surgical localization of gastro-intestinal bleeding and other pathological lesions, which has an internally illuminated translucent body that is inserted into an opening of the stomach or other tissue to be examined at surgery and placed against regions of stomach wall to be exposed for examination. Light projected from the body through stomach wall regions stretched over the body localizes bleeding lesions in such regions by visual contrast.

United States Patent [191 Corriero SURGICAL LOCALIZATION AND CONTROL OFGASTRO-INTESTINAL BLEEDING [76] Inventor: William P. Corriero, 74-lstSt.,

Garden City, N.Y.' 11530 [22] Filed: Apr. 14, 1972 [21] Appl. No.2244,067

[52] US. Cl. 128/23, 128/2 R, 240/2 M [51] Int. CL; A6lb 1/06 [58] Fieldof Search 128/2 R, 23, 395,

128/396, 397, 398; 350/175 SL; 240/1 EL, 2 E, 2 G, 2 M, 2 R

[56] References Cited UNITED STATES PATENTS 1,662,150 3/1928 Kerr 128/232,247,258 6/1941 Shepa'rd..... 128/397 X 3,675,005 7/1972 Curiel 240/2 RNov. 13, 1973 3,068,739 12/1962 Hicks, Jr. et al 128/395 UX 1,755,3154/1930 Chubb 350/175 SL X 2,316,301 4/1943 Ullman 240/2 M X FOREIGNPATENTS OR APPLICATIONS 319,755 9/1930 Great Britain 128/23 PrimaryExaminer-Lucie H. Laudenslager Att0meyBucknam and Archer 57 ABSTRACT 4Claims, 2 Drawing Figures PATENIEDNUV 13 ms 3771. 516

SHEET 10F 2 13 l/IJ FIG. 1

PAIENIEUnuv 1 3 191a SHEET 2 OF 2 Y mm;

SURGICAL LOCALIZATIONAND CONTROL OF GASTRO-INTESTINAL BLEEDINGBACKGROUND AND SUMMARY OF THE INVENTION This invention relates ingeneral to instruments used at surgery, and more particularly to aninstrument for surgical localization and control of gastro-intestinalbleeding and other pathological lesions.

In the prior art, much has been published on the diagnosis ofgastro-intestinal bleeding but very little has been offered in the wayof equipment and techniques for aiding the surgeon to effectivelylocalize and control this type of bleeding at surgery. Many abdominalsurgeons have at one time or another suffered the frustration of havingat hand a widely opened and bleeding stomach and being helplessly unableto find the source of hemorrhage,let alone control it. Under such asituation, the patient frequently either dies or must undergo a majorsurgical resection. It is the purpose of this invention to provide aninstrument whereby a bleeding lesion in any hollow viscus can be moreeasily localized and controlled at surgery.

The concept and principle of the invention is somewhat analogous tothe-darning egg used as an aid in the mending of socks. As is well knownin the hosiery repair art, a darning egg is inserted in to an opening ofthe sock, and the sock material is pulled snugly over the egg so as toclearly reveal the defect and provide fenestration over-which a repaircould be accomplished with ease.

In the early development of the invention, there were used laboratoryvolumetric flasks of various different graduated sizes up to one litter.Such flasks, commonly called Florentine flasks, each have a clear,translucent and transparent spherical body and a long narrow neck.Before using one of these flasks to aid in localizing gastro-intestinalbleeding lesions, the bleeding stomach is opened and flushed generouslywith copious amounts of water or saline until it is cleansed of allgross blood. A volumetric flask of adequate proportion is then chosenand the body of the flask is inserted through the gastronomy opening,manipulating the flask by holding it at its long neck. The flask is thenmoved about keeping the stomach wall stretched over the flask body,while an assistant is constantly flushing and suctioning the cavity ofthe viscus. The flask is so manipulated as to stretch the stomach wallover the body of the flask thereby flattening the folds and rugae of themuscosa. At each point of bleeding, a visibly contrasting tell-taleconcentration of bloody staining will pinpoint the lesion. Having thuslocalized the bleeding, it can then be controlled without removing theflask and thereby risking loss of precise localization. With the flaskbody against the stomach region containing the bleeding lesion, thebleeding is stemmed by a thru'and-thru suture from the serosal side ofthe viscus. Having controlled the bleeding, the ligating suture is thenburied in the wall of the stomach by an imbricating serosal closure.

In the further development of the invention, other modifications wereadoped, one of which was the insertion of a diagnastic light into theflask body through an oburating cork in the mouth of the flask. Thisgave the flask artificial internal illumination over and above whateverinternal illumination resulted from external ambient light enteringthrough the open flask mouth.

By providing this artificial illumination, many advantages were morereadily realized, among which were that the inner wall of the flaskstayed cleaner and recognition of the bleeding lesions became easierbecause of a higher level of transillumination.

By using green color illumination within the flask, it became easier toidentify bleeding lesions because green lighting gives a deep blackcolor to blood and blood vessels and more contrast with the coloring ofthe background tissue.

The invention can thus be characterized as an instrument for surgicallocalization of pathological lesions, and which has a translucent bodydisposed for insertion into an opening of tissues to be examined atsurgery. This body is moveable with its outside surface placed againstregions of the tissue, such as stomach wall to be exposed forexamination. The translucent body is furthermore disposed for internalillumination, whether by ambient or artificial light, so' as to projectlight through the regions of tissue placed against the body to therebylocalize lesions in such regions by visual contrast.

In preference to using glass laboratory flasks to make the instrument ofthe invention, plastic parts are used so as to eliminate breakagehazards and to facilitate manufacturing.

While the invention is ideally suited for use in connection withgastro-intestinal bleeding lesions, it is also adaptable for localizingand controlling other pathological lesions, such as bowel lesions,ulcerations, perforations and polyps. In any particular case, the sizeof the translucent body is chosen according to the size of the insertionopening allowable. v

For a better understanding of the invention and its several advantagesand applications, reference should be had to the accompanying drawingand following detailed description which exemplify preferred embodimentsof the invention.

BRIEF DESCRIPTION OF THE DRAWING In the drawing:

FIG. 1 is a schematic longitudinal section view of an instrumentaccording to a preferred embodiment of the invention.

FIG. 2 is a schematic longitudinal section view of an instrumentaccording to another embodiment of the invention.

DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION FIG. 2 shows aninstrument It) for'the surgical localization of pathological lesionssuch as gastro-intestinal bleeding in the wall of the stomach of apatient under examination at surgery. Instrument 10 has a translucentbody 1 l, which can, if desired, be clear and transparent also, the body11 being disposed for insertion into an opening of the stomach wallcreated'at surgery, and for movement with its outside surface 12 placedagainst regions of the tissue to be exposed for examination. Body 11 isexpediently made of solid clear plastic and is connected to an extendingtubular neck member 13, also made of clear plastic. Neck 13 serves as ahandle for manipulating the instrument l0 and at the outer end of neck13 is connected a cold-light source 14, expediently operated by electricpower. Source 14 is optically coupled to the body 11 through thelight-transmitting tubular neck 13 whereby body 11 is internallyilluminated by source 14 to project light through the regions of tissueplaced against body surface 12. The light thus projected through thetissue areas spread out against body 11 allows lesions such as bleedingto be localized precisely by visual contrast with the normal tissue areas. It has been found that by using green color lighting of body 11 theblood and blood vessels are made to appear with a deep black color,making them more easily identifiable. Accordingly, the source 14 isprovided with a green filter 15 or other suitable means (not shown) togive source 14 a green color light output.

FIG. 2 shows an instrument 10A in which the clear plastic translucentbody 11A is hollow as is the neck 13A connected thereto. A fibro-opticlight transmitting member 16 extends through neck 13A into the interiorof body 11A. The fibro-optic member 16 is expediently a rod-like bundleof glass or plastic fibres each capable of lengthwise transmission oflight rays from a light source 14A to the output end 17 of member 16.Member 16 is supported generally coaxially with neck 13A by braces 18and 19 disposed therein and connected thereto.

Member 16 is rotatable relative to body 11A and neck 13A and isconnected to source 14A by a rotary joint. A knob 20 connected tofibro-optic member 16 beyond the end of neck 13A facilitates turning ofmember 16 to internally illuminate with greater intensity selectedregions of body 11A. The brace 18 at the end of neck 13A can be in theform of a cork which seals the entrance of neck 13 against entry byforeign matter but which has a central passage accommodating theextension therethrough of member 16.

From the foregoing it can be provided by the artisan that the inventionis adaptable to many uses and the dimensions of the instrument 10A, canbe scaled up or down as desired to suit particular purposes.

What is claimed is:

1. An instrument for surgical localization of pathological lesions whichcomprises a hollow translucent body disposed for insertion into anopening of tissue to be examined at surgery, and for movement with theoutside surface of the body placed against regions of tissue to beexposed for examination, an elongated handle connected to said body andextending therefrom, a light-transmitting member extending through saidhandle and into the hollow interior of said body to internallyilluminate same to thereby project light through the regions of tissueplaced against the body to localize lesions in such regions by visualcontrast, said light transmitting member being rotatably moveablerelative to said translucent body and handle to direct the lightprojected across different points of said regions.

2. An instrument according to claim 1 wherein said light-transmittingmember is a fibro-optic lighttransmitting member.

3. An instrument according to claim 1 wherein said light-transmittingmember is optically coupled to an external source of light to illuminatesaid translucent body.

4. An instrument according to claim 1 including a source of lightoptically coupled to said lighttransmitting member to internallyilluminate said trans lucent body with green color light.

1. An instrument for surgical localization of pathological lesions whichcomprises a hollow translucent body disposed for insertion into anopening of tissue to be examined at surgery, and for movement with theoutside surface of the body placed against regions of tissue to beexposed for examination, an elongated handle connected to said body andextending therefrom, a light-transmitting member extending through saidhandle and into the hollow interior of said body to internallyilluminate same to thereby project light through the regions of tissueplaced against the body to localize lesions in such regions by visualcontrast, said light transmitting member being rotatably moveablerelative to said translucent body and handle to direct the lightprojected across different points of said regions.
 2. An instrumentaccording to claim 1 wherein said light-transmitting member is afibro-optic light-transmitting member.
 3. An instrument according toclaim 1 wherein said light-transmitting member is optically coupled toan external source of light to illuminate said translucent body.
 4. Aninstrument according to claim 1 including a source of light opticallycoupled to said light-transmitting member to internally illuminate saidtranslucent body with green color light.